Bringing Ebola Home (part 2 of 2)

Eric Lis

How do you realistically introduce an Ebola-like illness into your campaign? One of the horrifying parts of an Ebola outbreak is that there's often several steps with a human component. A single man is bitten by an infected bat and falls ill. The man is taken to the temple of healing, where he is given a routine injection of some curative substance; the syringe is re-used by well-meaning healers and spreads virus a dozen other patients more. The bodies of the deceased are returned to their homes, where relatives clean and enshroud them; in doing so, they come in contact with blood and stool, becoming infected. If they have improper sanitation, mothers and fathers with unclean hands prepare meals for their children, who become infected, and bring the virus to their schools, where as every parent knows, infections spread like wildfire. Within a week, hundreds of men, women, and children carry a deadly virus. Although clerics can heal dozens of sick people per day, the sheer number of victims exceeds their spellcasting power, and the plague spreads faster than they can contain it.

Now let's make this even scarier. Suppose that one of the humanoid races is a reservoir for the virus. Let's pick the dwarves, because nobody ever suspects them of harbouring a plague. A single dwarf in the wild kills and eats a small monkey, and picks up the virus. His travels bring him through a human kingdom, where, through the necessities of living, he introduces the virus into the local water supplies. Human authorities scramble to figure out how the plague is being spread, and while all the standard precautions are being taken -- young women burned at the stake, cats drowned in lakes -- humans travelling to elven lands spread the contamination there. After a few wealthy and influential humans die, divination magic reveals that "patient zero" is a dwarf. Enraged by their losses, the humans attack and raze a dwarven village. Before you know it, the whole region is up in flames. The orcs take advantage of the chaos by launching a few raids of their own, and after they eat a few infected elves, everything just gets worse...

For the real worst-case scenario, imagine Ebola being unleashed as a form of bioterrorism. A single evil cleric or druid could potentially destroy entire kingdoms with a few carefully-cast spells. Of course, spells like Cause Disease and Contagion typically can't reproduce a disease as deadly as Ebola, and from a game mechanic point of view, this is for very good reason, but every medieval fantasy setting has its god or goddess of diseases and stronger magic and powerful rituals are plentiful. Should the evil cleric have a position of political power in the land, they would also be in a position to sabotage relief efforts. Actually, that sounds depressingly like what we read about in the newspapers these days...



Also known as: The bleeding death, familial curse

Ages: Any

Description: Ebola is a name that encompasses a group of viral illnesses with rapid and deadly effects. Ebola is particularly virulent in primate-like humanoids, including humans, but is infectious to elves, dwarves, orcs, and the vast majority of known sentient races and animals.

Ebola is spread through bodily fluids. The virus generally requires very close contact to spread. The highest risk is physical contact with an infected creature and sharing of fluids. Proper sanitation, especially hand washing, is powerfully protective. In regions without access to clean water, however, or in communities where the link between hand washing and health may not be known, it is all too common for blood or wastes to get on the hands and then be ingested when a creature eats. Infection is commonly spread within communities by ritualistic cleaning and handling of a dead body and spread between races and species by consuming poorly-cooked flesh of infected creatures. Infected blood can splash from one creature onto another in combat, and the virus is also sexually transmissible. Experts estimate that at a distance of about five feet, the risk of infection is near zero unless an infectious creature is for some reason actively spraying contaminated fluids.

Because of their propensity for unhygienic living conditions and uncooked flesh, Ebola is a particular slayer of orcish and goblinoid encampments in some regions. Some unscrupulous human towns have even resorted to deliberately infecting dead bodies with virus and leaving them for orcish scouts to find and bring back to their camps. While this can be an effective weapon, outbreaks triggered in this fashion can prove to be difficult to contain once unleashed and more than one human village has had their own plague sweep back upon them.

Because the infection spreads most easily among people in close and intimate contact, in the earliest stages of an outbreak, the illness may appear to be striking down one particular household or family. Because of this, superstitious communities may initially misunderstand Ebola as a curse targeting a single family. This notion will often quickly be disabused as the infection inevitably spreads to the rest of a surrounding community.

Ebola has a number of deadly effects on the body. Although it begins with seemingly harmless and non-specific symptoms such as cough and headache, it rapidly develops into severe gastrointestinal distress with vomiting and diarrhea. As the creature becomes dehydrated, blood pressure falls, damaging the kidneys, brain, and other organs. At the same time, the virus over-activates the body's immune response, causing widespread tissue breakdown, fever and pain. In the late stages of the infection, the blood loses its ability to clot properly, causing the infection's most visible and famous symptom, severe and uncontrolled bleeding. Ironically, although Ebola is considered a "hemorrhagic" illness, many creatures who contract it do not live long enough to develop significant bleeding.

Approximately seven out of every ten creatures who develop symptoms of Ebola die of the illness within two weeks of the onset of symptoms. Those who survive seem to take an unusually long time to regain their weight and strength.

Mechanics: A creature exposed to Ebola must make two Fortitude saves (DC 20), one immediately and one at the end of the incubation phase, 2d10 days later. If both saves fail, the creature becomes symptomatic and, at this point, infectious. First, the creature develops a fever, sore throat, and headache, and at this point the affected creature is considered to be Sickened. After 1d4 days, symptoms worsen, evolving into vomiting and diarrhea. The creature becomes Nauseated, and must make two Fortitude (DC 15) saves each day. For each failed save, the creature suffers two points of Constitution damage. This ability damage heals at one half the normal rate (i.e., one point every two days or one point for every day of complete bed rest). If the creature succeeds on both Fortitude saves for three consecutive days, the infection is cleared and no further saves are necessary.

Treatment: A Remove Disease spell cures Ebola instantly, but has no effect on ability damage already accumulated. Without Restoration spells or similar magic, ability damage continues to heal at one half the normal rate until it is healed completely.

The Heal skill may be used in place of an infected creature’s Fortitude saves both to prevent infection and to avoid Constitution damage. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on October 25, 2014. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system